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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
(Rev. February 2004) Notice of Federal Tax Lien
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS /SELF EMPLOYED AREA #2'
Lien Unit Phone: (800) 913 -6050 940207713 �3
As provided by section 6321, 6322, and 6323 of the Internal Revenue
Code, we are giving a notice that taxes (including interest and penalties) -
have been assessed against the following -named taxpayer. We have made
a demand for payment of this liability, but it remains unpaid. Therefore,, co
there is a lien in favor of the United States on all property and rights to - —y c
property belonging to this taxpayer for the amount of these taxes, and < Ca
additional penalties, interest, and costs that may accrue.
p -fir-
Name of Taxpayer HARRY M SHAW III i
Residence 83 RUSTIC DR
SHIPPENSBURG, PA 17257 - 8751
IMPORTANT RELEASE INFORMATION For each assessment listed below,
unless notice of the lien is refiled by the date given in column (e), this notice shall, 7� T
on the day following such date, operate as a certificate of release as defined P
in IRC 6325(a).
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2008 XXX -XX -5341 04/15/2009 05/15/2019
1040 12/31/2008 XXX -XX -5341 11/14/2011 12/14/2021
1040 12/31/2008 XXX -XX -5341 07/09/2012 08/08/2022 32849.47
Place of Filing
Prothonotary
Cumberland County Total $ 32849.47
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 17th day of May 2013
Signature Title
REVENUE OFFICER 22 -06 -1418
for JAKOB PEDERSEN (717) 777 -9621
(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien
Rev. Rul. 71 -466, 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2 -2004)
Part 1 - Kept By Recording Office CAT. NO 60025X